Slides with topics that are covered and were tested in the recent Absite exams. Nir Hus MD., PhD. http://www.nirhus.com

1. Absite Topic Review
General Surgery
Nir Hus, MD, PhD.
Mount Sinai Medical Center
Miami Beach
Nir Hus

2. Frontal views of LeFort complex
fractures I - III
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3. Lateral views of LeFort complex
fractures I - III
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4. LeFort I
 The LeFort I, or transmaxillary
fracture runs between the
maxillary floor and the orbital
floor.
 It may involve the medial and
lateral walls of the maxillary
sinuses and invariably involves
the pterygoid processes of the
sphenoid.
 Clinically, the floating fragment
will be the lower maxilla with the
maxillary teeth.
Nir Hus

5. LeFort II
 The LeFort II occurs along
yet another weak zone in the
face, and is sometimes
called a pyramidal fracture
because of its shape.
 A common mechanism is a
downward blow to the nasal
area.
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6. LeFort III
 The most severe of the classic LeFort
fractures.
 The entire face is a Large unstable (floating)
fragment.
 This fracture is also referred to as
craniofacial disassociation.
 This is a very severe injury, and is often
associated with significant injury to many of
the soft tissue structures along the fracture
lines.
 Considerable force is necessary to produce
this injury, and it is uncommon as an isolated
injury.
 It may also occur in association with severe
skull and brain injuries.
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7. Blowout Fracture
 The arrows point to the fracture fragments and
periorbital tissue which have herniated into the
maxillary sinus Nir Hus

8. Blowout Fracture
 The forces being transmitted by the soft tissues of the orbit
downward to the thin floor of the orbit.
 The floor is usually the path of least resistance, and fractures
downward into the maxillary sinus.
 Common clinical signs are enophthalmos and diplopia
(especially on upward gaze), and one should remember that
about 24 % of these fractures are associated with ocular injury as
well.
 On a Waters view, one may see a soft tissue mass on the superior
margin of the maxillary sinus, representing the herniated periorbital
tissues into the sinus.
 One may also see a "trapdoor" fragment of bone protruding down
into the sinus, often hinged on the ethmoidal side.
 CT will, of course, show these fractures and soft tissue mass much
better.
Nir Hus

9. Common sites of Mandibular
fractures
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10. Mandibular fractures
 Fractures are obvious on clinical exam.
 Clinical findings include facial distortion,
malocclusion of the teeth, or
abnormal mobility of portions of the
mandible or teeth.
 The mandible is one of those bones
covered by the "ring bone rule .
 A fracture or dislocation in a ring bone or
ring bone equivalent, should prompt a look
for another fracture or dislocation.
Nir Hus

11. Mandibular fractures
 This tendency of ring bones to break in more than one
place can be illustrated by going through a bag of
pretzels and trying to break one of them in just one
place. Then try it with a bag of bagels. This is called the
Lee Rogers "pretzel-bagel spectrum".
 The stiffer a ring bone is, the more likely it is to break in
more than one place.
 The more flexible it is, the more likely it is to break in just
one place.
 The mandible has some flexibility, due not only to the
mobility around the temporomandibular joints (TMJ's) but
also to the tendency of the TMJ's to absorb some forces
during trauma.
Nir Hus